Provider Demographics
NPI:1689948671
Name:WEIBLE, KENDRA K (MSS, LSW)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:K
Last Name:WEIBLE
Suffix:
Gender:F
Credentials:MSS, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CREEKSIDE DR
Mailing Address - Street 2:SUITE 601
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-9204
Mailing Address - Country:US
Mailing Address - Phone:610-326-2728
Mailing Address - Fax:610-326-2750
Practice Address - Street 1:600 CREEKSIDE DR
Practice Address - Street 2:SUITE 601
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-9204
Practice Address - Country:US
Practice Address - Phone:610-326-2728
Practice Address - Fax:610-326-2750
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127922104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1245267129OtherGROUP'S NPI # (INNOVATIVE COUNSELING)
PASW127922OtherPENNSYLVANIA BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS